Cryotherapy for Prostate Conditions

Cryotherapy for Prostate Conditions

(Also known as: Cryosurgery and Cryoablation)

Procedure Overview

What is cryotherapy?

Cryotherapy is a procedure that involves killing cancer cells by freezing them and surrounding them with ice crystals. Tiny needles are placed directly into the tumor then argon gases are passed through the needles and exchanged with helium gases. This causes a freezing and warming cycle. A urethral warming catheter keeps the urethra warm throughout the procedure to prevent the urethra from freezing.

For prostate treatment, the needles are often inserted using transrectal ultrasound (TRUS) guided technology.

What is the prostate gland?

Illustration of the anatomy of the male reproductive tract
Click Image to Enlarge

The prostate gland is about the size of a walnut and surrounds the neck of a man's bladder and urethrathe tube that carries urine from the bladder. It's partly muscular and partly glandular, with ducts opening into the prostatic portion of the urethra. It's made up of three lobes, a center lobe with one lobe on each side.

As part of the male reproductive system, the prostate gland's primary function is to secrete a slightly alkaline fluid that forms part of the seminal fluid (semen), a fluid that carries sperm. During male climax (orgasm), the muscular glands of the prostate help to propel the prostate fluid, in addition to sperm that was produced in the testicles, into the urethra. The semen then travels through the tip of the penis during ejaculation.

Researchers don't know all the functions of the prostate gland. However, the prostate gland plays an important role in both sexual and urinary function. It's common for the prostate gland to become enlarged as a man ages, and it's also likely for a man to encounter some type of prostate problem in his lifetime.

Many common problems are associated with the prostate gland. These problems may occur in men of all ages and include:

Cancer of the prostate is a common and serious health concern. According to the American Cancer Society (ACS), prostate cancer is the most common form of cancer in men older than age 50, and the third leading cause of death from cancer.

There are two other types of treatments that can be used for either BPH or prostatectomy. However, there hasn't yet been enough research done to prove their long-term effects.

Why is cryotherapy used?

Cryotherapy may be used in patients with low-risk tumor factors, such as an original prostate specific antigen (PSA) level less than 10 ng/mL, Gleason score lower than 6, and less advanced clinical stage (for example, T1c or T2a, and some say, even up to T3a). A Gleason score is a way of grading prostate cancer cells on a scale of 2 to 10. The higher the number, the faster the cancer will likely grow and the more chance it will to spread beyond the prostate. Men who aren't as concerned about their erectile function after surgery may consider cryosurgery as an option, as the risk for temporary or permanent impotence after the procedure is high.

When the intent is not to cure, cryosurgery may be useful for patients who have disease that has spread beyond the prostate gland and need treatment for symptoms. Sometimes cryoablation may be used as an alternative for patients who have had unsuccessful results with radiation therapy. Some experts believe cryotherapy can be helpful when the prostate cancer cells aren't as sensitive to radiation.

Cryotherapy may not be recommended for men who have a very large prostate gland.

Cryosurgery is also used because it's less invasive than radical prostatectomy, and subsequently, there's generally less blood loss, a shorter hospital stay (or even no hospital stay), shorter period of recovery, and less pain.

Cryosurgery has only been used since the late 1990s. Because there are no long-term studies of cryosurgery available, it may not be among the first options presented to many prostate cancer patients. However, initial studies indicate that cryotherapy is a safe and effective treatment.

There may be other reasons for your physician to recommend cryotherapy.

What are the risks of the procedure?

As with any procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

Here are some things you can expect:

Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Cryosurgery may require a one-day stay in the hospital. It may also be done as an outpatient procedure. Procedures may vary depending on your condition and your physician's practices.

Illustration of cryotherapy procedure
Click Image to Enlarge

Generally, cryotherapy follows this process:

  1. You'll be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You'll be asked to remove your clothing and will be given a gown to wear.
  3. You'll be asked to empty your bladder prior to the procedure. An intravenous (IV) line will be started in your arm or hand.
  4. The surgeon will first place a catheter into the bladder to drain urine from it. The catheter will be placed through the urethra and the bladder will be filled with saline solution. This will help to keep urine draining even if the prostate gland swells after the treatment. The catheter will also be used for the circulation of a warm liquid to protect the urethra from the cold temperatures used during the procedure.
  5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Once you're sedated, a breathing tube may be inserted through your throat into your lungs and you will be connected to a ventilator, which will breathe for you during the surgery.
  6. The surgeon may choose regional anesthesia instead of general anesthesia. Regional anesthesia is medication delivered through an epidural catheter (in the back) to numb the area to be operated on. You'll receive medication to help you relax and analgesic medication for pain relief. The surgeon will be able to talk to you during the procedure. The surgeon will determine which type of anesthesia is appropriate.
  7. You'll be placed on your back on the operating table with your legs up in stirrups.
  8. The surgeon will insert the cryoprobes (needles) into the preselected areas between the scrotum and anus. A liquid cooling agent (usually argon) will be placed into the needles, which eventually freezes the entire prostate gland. The frozen area will stay frozen for only a few minutes then will be thawed by inserting helium through the needle probes. This cycle may be repeated once.
  9. The surgeon will view ultrasound images to assess the freezing process to ensure only the affected tissue is being treated.
  10. The needles will be extracted and the urinary catheter will remain in the bladder.
  11. A sterile bandage/dressing will be applied.
  12. You'll be transferred from the operating table to a bed then taken to the recovery room.

After the Procedure

After the procedure, you may be taken to the recovery room before being taken to a hospital room. You'll be connected to monitors that will constantly display your heart rate (electrocardiogram tracing, ECG or EKG), blood pressure, other pressure readings, breathing rate, and your oxygen level.

Once your blood pressure, breathing, and pulse are stable and you're alert, you'll be taken to your hospital room.

You may receive pain medication as needed, either by a nurse, or by administering it yourself through a device connected to your intravenous line.

Once your condition has stabilized, you may start liquids to drink. Your diet may be gradually advanced to more solid foods as you're able to tolerate them.

Your recovery will continue to progress. You'll probably have some bruising and swelling in the perineum where the probes were inserted. You should be allowed to walk the same day and you may be able to go home the same or the next day.

You may notice some blood in your urine for a day or two after the surgery. Swelling in the penis or scrotum is common. You may also experience pain in the abdomen and burning sensations, which may make you feel an urge to go to the bathroom more often.

The catheter will stay in for a couple of weeks to help urine drain while your prostate gland heals.

Due to nerve damage caused by the freezing process, impotence (erectile dysfunction) will occur in most men who have this treatment.

Urinary incontinence may also result from cryosurgery. Your physician will give you suggestions for how to manage this side effect.

Arrangements will be made for a follow-up visit with your physician.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

At home

Once you're home, it'll be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions.

The needle insertion sites and the catheter incision may be tender or sore for several days after cryosurgery. Take a pain reliever for soreness as recommended by your physician.

You shouldn't drive until your physician tells you to. Other activity restrictions may apply.

Notify your physician to report any of the following:

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and wasn't designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we don't control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Cancer Society

American Urological Association

American Urological Association Foundation

National Association for Continence

National Cancer Institute (NCI)

National Coalition for Cancer Survivorship

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Prostate Cancer Coalition

Prostatitis Foundation

Us TOO International, Inc.

 

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